Severe bullous skin diseases: analysis of seven children managed in a burns unit

Area of Science:

• Pediatric Dermatology
• Critical Care Medicine
• Infectious Diseases

Background:

• Severe bullous skin diseases pose diagnostic challenges in pediatrics.
• Burns units offer specialized care essential for managing extensive cutaneous loss.
• Differentiating conditions like toxic epidermal necrolysis and staphylococcal scalded-skin syndrome is critical.

Purpose of the Study:

• To report on the management of severe bullous skin diseases in pediatric patients treated in a burns unit.
• To highlight the diagnostic and therapeutic approaches for these conditions.
• To assess the outcomes and mortality associated with severe bullous eruptions in children.

Main Methods:

• Retrospective case series of seven pediatric patients treated between 2001-2005.
• Inclusion of patients managed in a burns unit with pediatric intensive care cooperation.
• Diagnosis confirmed via skin biopsy and culture swabs.
• Management protocols similar to mixed second-degree burns, including fluid calculation, hydrotherapy, and closed dressing techniques.

Main Results:

• Five cases of toxic epidermal necrolysis (Lyell's syndrome), one staphylococcal scalded-skin syndrome, and one generalized drug eruption were identified.
• Mortality rate was 14% (one patient).
• Patients typically presented with significant body surface area involvement (70-80%), characterized by substantial desquamation and bullous formation.
• Common symptoms included high fever, systemic toxicity, and extensive mucocutaneous exfoliation.

Conclusions:

• Burns units provide an optimal environment for managing severe pediatric bullous skin diseases.
• Prompt diagnosis and treatment, mirroring burns care, are vital for patient survival.
• Effective multidisciplinary collaboration between burns and pediatric intensive care units is essential.